Considerations for Development of Exposure Limits for Chemicals Encountered During Aircraft Operation.

BACKGROUND: Military aircrews' health status is critical to their mission readiness, as they perform physically and cognitively demanding tasks in nontraditional work environments. Research Objectives: Our objective is to develop a broad operational risk assessment framework and demonstrate its applicability to health risks to aircrews because of airborne chemical exposure, considering stressors such as heat and exertion. METHODS: Extrapolation of generic exposure standards to military aviation-specific conditions can include computation of risk-relevant internal dosimetry estimates by incorporating changes in breathing patterns and blood flow distribution because of aspects of the in-flight environment. We provide an example of the effects of exertion on peak blood concentrations of 1,2,4-trimethylbenzene computed using a physiologically based pharmacokinetic model. RESULTS: Existing published collections on the effects of flight-related stressors on breathing patterns and blood flow address only a limited number of stressors. Although data exist that can be used to develop operational exposure limits specific to military aircrew activities, efforts to integrate this information in specific chemical assessments have been limited. CONCLUSIONS: Efforts to develop operational exposure limits would benefit from guidance on how to make use of existing assessments and expanded databases of the impact of environmental stressors on adult human physiology.

Novel Approach for Detecting the Neurological or Behavioral Impact of Physiological Episodes (PEs) in Military Aircraft Crews.

INTRODUCTION: Military and civil aviation have documented physiological episodes among aircrews. Therefore, continued efforts are being made to improve the internal environment. Studies have shown that exposures to many organic compounds present in emissions are known to cause a variety of physiological symptoms. We hypothesize that these compounds may reversibly inhibit acetylcholinesterase, which may disrupt synaptic signaling. As a result, neural proteins leak through the damaged blood-brain barrier into the blood and in some, elicit an autoimmune response. MATERIALS AND METHODS: Neural-specific autoantibodies of immunoglobulin-G (IgG) class were estimated by the Western blotting technique in the sera of 26 aircrew members and compared with the sera of 19 normal healthy nonaircrew members, used as controls. RESULTS: We found significantly elevated levels of circulating IgG-class autoantibodies to neurofilament triplet proteins, tubulin, microtubule-associated tau proteins (Tau), microtubule-associated protein-2, myelin basic protein, and glial fibrillary acidic protein, but not S100 calcium-binding protein B compared to healthy controls. CONCLUSION: Repetitive physiological episodes may initiate cellular injury, leading to neuronal degeneration in selected individuals. Diagnosis and intervention should occur at early postinjury periods. Use of blood-based biomarkers to assess subclinical brain injury would help in both diagnosis and treatment.

Skyborn: in-flight emergency births on commercial airlines.

BACKGROUND: This study reports the global occurrence of in-flight emergency births on commercial airlines. To date, no existing research investigating in-flight emergency births has been published. METHODS: A retrospective study was conducted of all known in-flight births on commercial airlines between 1929 and 2018. RESULTS: Between 1929 and 2018, there were 74 infants born on 73 commercial flights. Seventy-one of the infants survived delivery, two died shortly after delivery and the status of one is unknown. Seventy-seven percent of the flights were designated international flights, and 26% of all flights were diverted due to the in-flight emergency births. The gestational age at delivery ranged from 25 to 38 weeks with 10% of the infants born at 37-38 weeks, 16% born at 34-36 weeks, 19% born at 31-33 weeks and 12% born prior to 32 weeks. Physicians, nurses, the flight crew and other medical personnel provided medical assistance in 45% of the births. CONCLUSION: In-flight emergency births are infrequent but not trivial. Commercial airlines are dependent on physicians and other medically trained passengers to help with in-flight deliveries.Despite US Federal Aviation Authority and Joint Aviation Authority standards, on-board medical and first aid kits are depleted and inadequate for in-flight deliveries.

Urological In-Flight Medical Events on Commercial Airlines.

PURPOSE: In-flight medical events are rare but may cause significant distress as access to care is limited. There is a paucity of data on in-flight urological medical events. We describe urological in-flight medical emergencies and report clinical and flight outcomes. MATERIALS AND METHODS: We reviewed all in-flight urological medical emergencies between 2015 and 2017 from MedAire®, a ground based medical support center that provides remote medical advisory services to approximately 35% of commercial airline passenger traffic worldwide. Our primary end point was the incidence rates of in-flight urological medical events. We also characterized the types of in-flight medical emergencies, in-flight management and their impact on flight status. Statistical analyses included Student's t-tests, chi-square analysis and analysis of variance. RESULTS: We identified 1,368 (1%) urological in-flight medical emergencies from a total of 138,612 in-flight medical emergencies, with an incidence of 0.5 per million passengers. The most common in-flight medical emergencies were lower urinary tract symptoms (35%), urinary retention (30%) and flank pain (21%). Among in-flight medical emergencies 883 (60%) resolved in flight, 273 (28%) required on-arrival medical evaluation and 21 (1.5%) resulted in flight diversions. Of the flight diversions the majority were due to urinary retention (12, 57%) and less commonly flank pain (6, 28%) and testicular/abdominal pain (3, 15%). CONCLUSIONS: The most common causes of urological in-flight medical emergencies are lower urinary tract symptoms, urinary retention and renal colic, the majority of which resolved in flight. These data are useful for informing flight personnel and emergency kit equipment needs to minimize the impact of these events when they occur.

Restless Legs Syndrome in Aircrew.

INTRODUCTION: Restless legs syndrome (RLS) is characterized by an uncomfortable sensation on the legs, which causes the urge to move the legs. The main cause is unknown but there are many risk factors, including geographical properties and high altitude. Our objective was to explore the frequency of RLS in aircrew.METHODS: There were 301 Turkish aircrew who were admitted to Istanbul Medipol University Hospital Neurology Department for periodic examinations and 272 healthy (non-aircrew) subjects included in the study. The International RLS Study Group's Questionnaire and the International RLS Study Group Rating Scale (IRLSSGRS) were used to evaluate RLS. The participants filled the RLS questionnaire and then both groups were divided into two subgroups as having RLS or not. The subjects years in the profession, average flight duration in a month, daily sleep duration, smoking, and coffee consumption were recorded. None of the subjects had previously been diagnosed with RLS.RESULTS: The frequency of RLS was 6.7% in the aircrew group and 7.9% in the control group, and there was no significant difference between the two groups. Age, gender, daily duration of sleep, smoking, coffee consumption, family history of RLS, being a pilot or a flight attendant, years in profession, and monthly flight hours were similar in aircrew with and without RLS.DISCUSSION: The RLS frequency in aircrew was similar to that of the control group. We can conclude flying at high altitude wasnt a risk factor for RLS.Düz OA, Yilmaz NH, Olmuscelik O. Restless legs syndrome in aircrew. Aerosp Med Hum Perform. 2019; 90(11):934937.

Association of Medical Certification Factors with All-Cause Mortality in U.S. Aviators.

INTRODUCTION: The value of aeromedical certification in reducing adverse medical outcomes is an especially important question for this era of increasing flight operations that do not require an FAA medical certificate. The study of this question has previously been thwarted by a lack of information about pilots when their medical certificates are not renewed.METHODS: We matched airmen in the FAA medical certification database to the U.S. Social Security Death Index to identify date of death for deceased pilots. Logistic regression models were used to explore associations of certification data with odds of death while holding a medical certificate and within 4 yr of expiration of a medical certificate.RESULTS: FAA aeromedical waivers were associated with 33% lower odds of death while holding a medical certificate and 35% increased odds of death within 4 yr after expiration of a medical certificate. Denial was associated with 21% increased odds of death in the next 4 yr. Only 13 of 47 medical conditions having significant associations were associated with increased odds of death during certification.DISCUSSION: We found that FAA aeromedical certification reduces the odds of death while holding a medical certificate compared to the 4 yr after certificate expiration. We believe this helps provide a positive answer to the question of whether medical certification reduces medically related events.Mills WD, Greenhaw RM. Association of medical certification factors with all-cause mortality in U.S. aviators. Aerosp Med Hum Perform. 2019; 90(11):938-944.

A Medical Review of Fatal High-G U.S. Aerobatic Accidents.

INTRODUCTION: Exposure to high G force is a known safety hazard in military aviation as well as civilian aerobatic flight. Tolerance to high G forces has been well studied in military pilots, but there is little research directed at civilian pilots who may have medications or medical conditions not permitted in military pilots.METHODS: In this case-control study, we identified 89 fatal high-G aerobatic accidents and 4000 fatal control accidents from 1995 through 2018 from the NTSB accident database and the FAA autopsy database. We retrieved medications and medical conditions from the FAA's pilot medical databases. Logistic regression models were used to explore the associations of drugs, medical conditions, height, and medical waivers with high-G accidents.RESULTS: Seven drugs (alprazolam, clonidine, ethanol, meclizine, phentermine, triamterene, and zolpidem) reached statistical significance in our models, but had such small case counts that we consider these findings to be uncertain, except for ethanol, which was found in seven cases. Of these, only triamterene was known to the FAA. Statistically significant medical predictors included only alcohol abuse (seven cases) and liver disease (only two cases).DISCUSSION: Our analysis found that the drug ethanol and the condition alcohol abuse are significantly associated with high-G accidents. Seven other factors were statistically significant, but should only be considered as hypothesis generating due to very low case counts. Our study does not suggest that restricting pilots with otherwise permissible medications or medical conditions from aerobatics is warranted.Mills WD, Greenhaw RM, Wang JMP. A medical review of fatal high-G U.S. aerobatic accidents. Aerosp Med Hum Perform. 2019; 90(11):959-965.

A Systematic Review and Meta-Analysis About the Prevalence of Neck Pain in Fast Jet Pilots.

BACKGROUND: During flight, fast jet pilots frequently move their heads into extreme positions while withstanding large amounts of stress on their cervical spines. These factors are thought to contribute to episodes of neck pain.METHODS: We conducted a systematic review and meta-analysis of previous neck pain prevalence data in fast jet pilots to determine an overall pooled prevalence. Subgroup analyses were performed according to when pilots complained about their neck pain, whether these same pilots sought treatment, and if they lost time from flying. Four research databases were searched. Studies were eligible for inclusion if they were written in English, involved a group of fast jet pilots who were actively flying high performance aircraft, and reported quantitative prevalence data about neck pain in these pilots. These eligibility criteria were independently applied by two reviewers and risk of bias was evaluated. MetaXL software was used to conduct the meta-analysis.RESULTS: In total, 8003 fast jet pilots across 18 eligible studies were included in the review. The overall pooled prevalence of neck pain in fast jet pilots was 51%. It was found that 39% of subjects lost time from flying, while only 32% sought medical treatment.DISCUSSION: Neck pain in fast jet pilots adversely affects operational capabilities of defense forces. The prevalence of neck pain varies according to the definitions or thresholds of complaints used across the literature. Further research is required to standardize the definition of neck pain.Riches A, Spratford W, Witchalls J, Newman P. A systemic review and meta-analysis about the prevalence of neck pain in fast jet pilots. Aerosp Med Hum Perform. 2019; 90(10):882-890.

Hypertension and Obesity Among Civil Aviation Pilots.

BACKGROUND: Raised blood pressure (BP) is a risk factor for cardiovascular disease, which is a common cause of sudden in-flight incapacitation among pilots. Prevalence of hypertension (HT) among pilots as per new criteria is largely unknown. This study aims to understand the prevalence of hypertension and obesity in civil aviation pilots and their correlation.METHODS: Enrolled were 1185 civilian pilots reporting for medical evaluation to a regulatory medical establishment in India. Their height, weight, and blood pressure (BP) were measured. Pilots were categorized as hypertensive or normotensive as per JNC VIII criteria and hypertensive, having elevated BP, or normotensive as per new ACC/AHA criteria of 2017. Data were analyzed for prevalence of obesity and overweight as per both WHO and Asia Pacific criteria. Results were analyzed using SPSS version 17.RESULTS: Prevalence of hypertension was 4.1%. Maximum hypertensives were in the 26-35 yr age group. Under the new ACC/AHA guidelines, prevalence of HT was 18.7%. Prevalences of overweight and obesity as per WHO criteria were 39% and 7.3% and as per Asia Pacific guidelines were 23.3% and 46.3%, respectively. As BMI increased above 23, risk of developing hypertension or white coat hypertension as per JNC VIII criteria increased by 6.86 times (OR 6.86, 95% CI 0.9-52.58).CONCLUSIONS: Prevalence of HT rose from 4.1% to an alarmingly high 18.7% when new criteria were applied. Prevalence of obesity was 7.3% but increased to 46.3% when Asia Pacific guidelines were applied. Risk of hypertension increased as BMI increased above 23 kg · m-2.Bhat KG, Verma N, Pant P, Marwaha MPS. Hypertension and obesity among civil aviation pilots. Aerosp Med Hum Perform. 2019; 90(8):703-708.

Medical Suspension in Female Army Rotary-Wing Aviators.

INTRODUCTION: Female aviators with health conditions may face a variety of occupational impacts. Outcomes may include a waiver for continued flight or a permanent suspension, in which flight is no longer possible. The objective of this study is to determine the prevalence of medical diagnosis among female U.S. Army aviators over a ten year period and identify associations of clinical diagnoses leading to waiver or permanent suspension. MATERIALS AND METHODS: This study was a secondary data analysis; data were retrieved on 1,282 female, rated aviator patients from an Army Aviation epidemiological database. The archival dataset was composed of a total of 6,856 cases between June 2005 and June 2015. Age ranged from 19 to 58 years. The data were examined in terms of raw ICD-9 diagnostic codes, grouped system diagnoses (diagnosis categories), and occupational consequence. Spearman's rho correlations were used to determine associations between diagnosis, waiver and permanent suspension. RESULTS: The leading diagnoses were pregnancy, normal delivery, and allergic rhinitis. The systems approach yielded pregnancy, orthopedic disorders, and spinal disorders as the leading diagnosis categories. Leading waivered conditions included spinal, psychiatric, and neurological disorders. In terms of permanent suspension, the leading cause was depression, followed by migraine and post-traumatic stress disorders. In almost all diagnostic groupings, the Spearman's rho correlation coefficients between age and diagnosis were positively related. However, age was not associated with negative occupational outcome (permanent suspension), generally. CONCLUSIONS: A variety of conditions negatively impact the health and occupational status of female aviators, with disparate occupational impacts. Prevalent conditions differed from those reported previously for all aviators in a predominantly male population. The absence of cardiovascular disease is a significant change from 20-30 years ago. Among all medical diagnoses, a minority are responsible for a greater occupational burden.

Insomnia, Work-Related Burnout, and Eating Habits Affecting the Work Ability of Flight Attendants.

BACKGROUND: Work ability is an important component of occupational health assessments and reflects how a persons' physical and mental health affect their ability to perform their job. However, little is known about factors relating to the work ability status of flight attendants. The aim of this study was to investigate the physical, mental, and work-related factors that affect flight attendants' work ability.METHODS: A questionnaire-based cross-sectional study and simple random sampling was conducted with participants employed at a Taiwan-based airline for longer than 1 yr. Analysis of variance and Pearson correlation tests were carried out to analyze work ability according to the flight attendants' social demographics, physical and mental health, and work-related factors. Multiple regression analysis was used to predict the flight attendants' work abilities.RESULTS: A total of 472 flight attendants were recruited and the response rate was 78.67%. The work ability of the flight attendants ranged from 'moderate' to 'excellent' (WAI score, 34.1 ± 1.8 to 45.1 ± 1.5). In a regression analysis, work ability was positively associated with gender, age, and good eating habits; in contrast, insomnia and work-related burnout were negatively associated with work ability (R² = 32.4%).DISCUSSION: Insomnia, work-related burnout, and eating habits had a significant impact on flight attendants' work abilities. Hence, it is important to address insomnia and high workloads and maintain a healthy lifestyle in the workplace.Hu C-J, Hong R-M, Yeh G-L, Hsieh I-C. Insomnia, work-related burnout, and eating habits affecting the work ability of flight attendants. Aerosp Med Hum Perform. 2019; 90(7):601-605.

U.S. Army Parachute Mishap Fatalities: 2010-2015.

INTRODUCTION: Despite the large number of U.S. military members who conduct parachuting operations, its inherent safety risks, and the introduction of a new military parachute in 2010, little has been published in the last decade on U.S. military parachute fatalities.METHODS: Parachute fatality investigative records maintained by the U.S. Army Combat Readiness Center were reviewed for U.S. Army fatalities resulting from military parachuting operations from January 1, 2010, through December 31, 2015. De-identified data on cases were collected, including causes, lethal injuries, and demographic, environmental, and missional factors. A descriptive analysis was performed.RESULTS: There were 13 cases which met study inclusion criteria. Most occurred during static-line operations and were jumps from a C-17 aircraft using a T-11 parachute. The two most common assigned accident codes were "improper or abnormal exit" and "unstable or improper body position," which combined accounted for 33% of cases. Also noteworthy at 11% each were "entanglement," "parachute malfunction," and "dragged on the drop zone," and at 6% each were "static line injury," "lost or stolen air," and "drop zone hazard." In 69% of cases blunt force trauma was the cause of death.DISCUSSION: Incident factors included human actions, equipment failure, and the environment. Death from blunt force trauma upon impact with the ground as the most frequent lethal injury was expected for parachute operations. This descriptive study provides awareness to military leaders of circumstances in which fatalities occur. Future investigations should include data on the total number of jumps to provide a more comprehensive analysis of risk.Johnson ES, Gaydos SJ, Pavelites JJ, Kotwal RS, Houk JE. U.S. Army parachute mishap fatalities: 2010-2015. Aerosp Med Hum Perform. 2019; 90(7):637-642.

Malaria Prophylaxis Adherence Among Aircrew Members.

INTRODUCTION: Joint Base Charleston's C-17 Globemaster III mission is executed by 400 active-duty members from three operational and support wings. Aircrew and mission-essential personnel travel to locations with endemic diseases which are mostly eradicated in the United States. Recently, two members contracted malaria after missions in Africa which required advanced hospital care. Personnel were provided chemoprophylaxis, but the members who contracted malaria were among several who chose not to take it. This preliminary survey assessed aircrew malaria prophylaxis adherence and examined potential factors contributing to nonadherence.METHODS: JB Charleston aircrew members who visited the Flight and Operational Medicine Clinic between January and April 2018 were administered a retrospective, online survey. Researchers performed descriptive statistics and Chi-squared analysis.RESULTS: Most respondents were pilots under 30 yr of age and were prescribed malaria chemoprophylaxis while on a mission. More than two-thirds of respondent aircrew members did not take the medication as prescribed or did not take it at all. Of those, over half of respondents stated too many pills/too many days and medication side effects as the main reasons for nonadherence. Furthermore, almost 70% of adherent members experienced negative medication side effects such as nausea and heightened dreams. There was no statistical relationship between crew position, age, side effects, and prophylaxis adherence.DISCUSSION: Numerous factors contribute to poor prophylaxis regimen compliance among aircrew members. This study highlighted the need for risk-based policy validation, improved patient education, prophylaxis enforcement, process improvements to facilitate adherence, and evaluation of perceived vs. actual risk.Rutherford AE, Yale RS, Finn MF. Malaria prophylaxis adherence among aircrew members. Aerosp Med Hum Perform. 2019; 90(7):643-646.

A Preliminary Study of U.S. Air Force Pilot Perceptions of the Pilot-Flight Surgeon Relationship.

INTRODUCTION: Flight surgeons play a vital role in U.S. Air Force aviation operations by ensuring that pilots are medically prepared to meet the demands of military aviation. However, there is natural tension between pilots and flight surgeons. A pilot may be reluctant to share medical information with a flight surgeon who could negatively impact the pilot's career or flight status. In this preliminary study, we sought to identify pilot-perceived strengths and weaknesses in the relationship between U.S. Air Force aviators and their flight surgeons. MATERIALS AND METHODS: An online survey regarding pilot-flight surgeon confidence and perceived values was distributed electronically to a convenience sample of U.S. Air Force aviators. Participants included U.S. Air Force active duty and Air Reserve Component (Air Force Reserve and Air National Guard) military aviators in addition to U.S. Air Force Academy aviation cadets. RESULTS: One hundred and seventy-three aviators participated in the survey. Respondents reported variable comfort in approaching flight surgeons with medical concerns and suggested that they believed other pilots might be withholding medical information from flight surgeons or seeking care from civilian physicians for career protection. CONCLUSIONS: We sought to examine the pilot-flight surgeon relationship and its impact on daily flying operations. While limited, results suggest that there may be gaps in trust between pilots and their flight surgeons. These findings could present an opportunity to improve the pilot-flight surgeon relationship by identifying factors that contribute to closer pilot-flight surgeon relationships.

Otitis Media with Effusion in Aircrew Members.

BACKGROUND: Middle-ear barotrauma is a common problem reported by aircrew members and passengers. Studies have shown that 20-50% of passengers report ear complaints during the flight or after landing. The aim of this study is to determine the prevalence of otitis media with effusion in aircrew members and describe the time to resolution of the condition.METHODS: All aircrew members presenting at Civil Aviation Center at Congonhas Airport at São Paulo for annual flight medical examinations from September 2014 to May 2015 were reviewed retrospectively for the presence of otologic disorders. Eligible participants were all pilots, copilots, and flight attendants with a diagnosis of otitis media with effusion confirmed by immittance testing.RESULTS: Of 1607 aircrew members, 155 (9.65%) were diagnosed as having otitis media with effusion. Most participants were men (51.6%). Regarding aircrew position, 81.9% were flight attendants, 11.6% were copilots, and 6.5% were pilots. The mean time to resolution of the otitis media was 8.23 (± 3.02) days.DISCUSSION: Otolaryngologists must be aware of the effects of gas expansion in the middle ear at higher altitudes for the appropriate treatment of diseases related to pressure changes. The recommendation for an aircrew member to return to flying duties should occur only after the individual has been treated and complete resolution, confirmed by immittance testing, has been documented.Pinto JA, dos Santos Sobreira Nunes H, dos Santos RS, Cavallini A, Freitas G, Knoll D, Duarte C. Otitis media with effusion in aircrew members. Aerosp Med Hum Perform. 2019; 90(5):462-465.

Risk of Fatigue Among Airline Crew During 4 Consecutive Days of Flight Duty.

BACKGROUND: Airline crew are being exposed to extended workdays and compressed work periods, with quick returns between duties, implying a heightened physiological and psychological strain that may lead to sleep deprivation and fatigue. The aim of the study was assessment of the effect of an extended day of flight duty and a compressed work week with regard to recovery, cumulative fatigue, and neurobehavioral performance.METHODS: We followed 18 pilots and 41 cabin crewmembers during four consecutive days of flight duty, comprising a total of ≥ 39 h, where the first day was ≥ 10 h. Information on demographics, work characteristics, health status, and physical activity was collected at baseline. Subjects completed logs for the first and fourth workday, including the Samn-Perelli Fatigue Checklist at three time points during these workdays. Two computer-based neurobehavioral tests were completed the evening prior to the first shift, and after the first and the fourth day of the work period.RESULTS: Number of flight sectors during the work period was 10-20. Self-reported fatigue levels increased during the workdays. Neurobehavioral test-scores did not deteriorate. The effects of each additional flight sector during the work period was elevated reaction times (RT) both among cabin crewmembers (B = 5.05 ms, 95% CI 0.6, 9.5) and pilots (B = 4.95 ms, 95% CI 0.4, 9.5). Precision was unaffected.DISCUSSION: Airline pilots and cabin crewmembers seem to obtain satisfactory sleep before and during the period of 4 consecutive days. The association between multiple flight sectors and increased fatigue supports previous findings.Goffeng EM, Wagstaff A, Nordby K-C, Meland A, Goffeng LO, Skare Ø, Lilja D, Lie J-AS. Risk of fatigue among airline crew during 4 consecutive days of flight duty. Aerosp Med Hum Perform. 2019; 90(5):466-474.

Occupant Injury Severity in General Aviation Accidents Involving Excessive Landing Airspeed.

BACKGROUND: Of all phases of flight operations, accidents during landings are the most frequent. Of these, poor speed management during landing has ramifications for injury severity since: 1) impact forces increase as a square of forward velocity; and 2) an aerodynamic stall, associated with inadequate landing speed, imparts high vertical G forces. Herein, the proportion of landing accidents involving deficient airspeed control and occupant injury severity was determined.METHODS: General aviation landing accidents (1997-2016) were identified from the NTSB database. An accident involving high-airspeed (high-energy) was one for which the NTSB cited airplane porpoising, multiple bounces, or floating, whereas an inadequate airspeed related (low energy) mishap was one citing this term or in which an aerodynamic stall occurred. An anonymous online survey of certificated pilots was used to inform landing technique. Statistical analyses used Poisson distribution and Chi-squared tests.RESULTS: Relative to the earliest period (1997-2001), the landing accident rate was undiminished for more recent years (2007-2016). Of 235 accidents, 38% involved high-energy, whereas 4% were inadequate airspeed-related. For the former, 17% resulted in occupants with fatal-serious injuries, twofold higher than for mishaps with no evidence of mis-speed. Of 1392 survey respondents, 73% selected a landing airspeed higher than required for an under-maximum weight airplane.CONCLUSION: For landing accidents involving airspeed mismanagement, those related to excessive energy predominate and are associated with more severe injuries. Two mitigating strategies are advanced: 1) pilot training should discuss landing airspeed adjustment for aircraft weight; and 2) installation of inflatable restraints for reducing injury severity should be encouraged.Boyd DD. Occupant injury severity in general aviation accidents involving excessive landing airspeed. Aerosp Med Hum Perform. 2019; 90(4):355-361.

Flight Anxiety Reported from 1986 to 2015.

BACKGROUND: Fear of flying is one of the most common phobias. It hinders people in performing their work and hampers family relations. Even though flight traffic has increased, there are new fears. Valid studies are needed to answer whether there have been changes in the prevalence of flight anxiety, are there sex differences in relation to fear of flying, use of alcohol, and tranquilizers, which situations cause the most flight anxiety, and whether the above factors have changed compared to a similar study from 1986.METHODS: A questionnaire was distributed to a representative random sample of the Norwegian population (N = 5500), where 36% answered. To assess flight anxiety across the time period, we used similar instruments to those we used in 1986.RESULTS: The prevalence of an assumed flight phobia decreased from 8% in 1986 to 3% in 2015. The percentage of those reported to never fly had decreased from 5% in 1986 to 0.5% in 2015. There were 11.0% who always used alcohol in 1986 and 7.5% in 2015 and 3% and 2%, respectively, always used tranquillizers. More women reported being afraid of both flying and other situations compared to men. Turbulence, unknown sounds, and fear of terror attacks caused the most anxiety.DISCUSSION: Flight anxiety still affects a considerable proportion of the Norwegian population and more women than men report that they are afraid of flying. However, in spite of methodology, people are significantly less afraid of flying than in 1986.Grimholt TK, Bonsaksen T, Schou-Bredal I, Heir T, Lerdal A, Skogstad L, Ekeberg Ø. Flight anxiety reported from 1986 to 2015. Aerosp Med Hum Perform. 2019; 90(4):384-388.

Flight Performance Aspects During Military Helicopter Flights.

INTRODUCTION: A flight is composed of many flight performance aspects. However, not all of these aspects are equally important for the success and safety of a flight. When investigating the influence of a stressor on flight performance, it is important to understand not only which flight performance aspects are important for the success and the safety of the flight, but also which of these aspects will most likely be affected by reduced alertness.METHOD: A total of 136 helicopter pilots of the Royal Netherlands Air Force (RNLAF) of all qualification levels were invited to participate in a three-round ranking Delphi study.RESULTS: A total of 41 (30%) helicopter pilots completed the first questionnaire round and 20 (77%) flight instructors completed the ranking round. The top ten skills elements comprised seven nontechnical skills (NTS), namely, awareness of the environment, decision making, workload management, stress management, planning and coordinating, general knowledge, and basic fitness; and three technical skills (TS), that is, advanced aircraft handling, flight maneuvers and procedures, and abnormal and emergency procedures. The top three ranked skill elements (awareness of environment, decision making, and workload management) were considered by the flight instructors to be highly influenced by reduced pilot alertness.CONCLUSION: NTS are considered more important and more affected by reduced pilot alertness during operational helicopter flight compared to TS.Steinman Y, van den Oord MHAH, Frings-Dresen MHW, Sluiter JK. Flight performance aspects during military helicopter flights. Aerosp Med Hum Perform. 2019; 90(4):389-395.